Emergency department (ED) crowding occurs when there are not enough resources and personnel to meet the demand for emergency care services [1]. ED crowding has a significant impact on the quality and accessibility of healthcare, including increased patient mortality rates, prolonged treatment times, diverted ambulance services, burnout among ED staff, increased likelihood of patients leaving without receiving care, and increased healthcare expenses [[2], [3], [4]]. To address this issue, the American College of Emergency Physicians (ACEP) established a task force to develop a comprehensive list of cost-effective and high-impact solutions [5]. These solutions encompass ED-based interventions, such as modifying the triage process using computer-assisted methods, as well as hospital-wide initiatives, such as immediate bedding [6].

Despite the release of the ACEP solutions, ED crowding continues to worsen [7]. Early reports on the adoption of ED crowding interventions suggest that even the most crowded US hospitals have not adopted many of the solutions [8]. This may be due to organizational factors, such as a lack of involvement from hospital leaders, insufficient resources, and external policies and regulations [9,10]. From a health policy perspective, it is important to understand how hospitals are responding to ED crowding at the national level. However, to the best of our knowledge, there is no nationwide study on the trends of adoption of ED crowding interventions among US hospitals. To address this gap, we conducted a study to report the trends in the adoption rate of ED crowding interventions among US hospitals.